Endoscopic surgery is performed by inserting the endoscope into a body cavity. The endoscopic image is displayed on its own monitor. The endoscope has its own carrier that may house other channels to accommodate surgical instruments, irrigation and suction. The endoscope provides wide angle view, the ability to look around the corner and enhanced illumination by bringing the light close to the target; all these features are desirable during surgical procedures. However, the main drawback of purely endoscopic surgery is the lack of 3-D viewing capability. In fact, many patient accidents during endoscopic procedures across all specialties are attributed to lack of a three-dimensional visualization. All these pluses and minuses apply to the use of the endoscope in all different types of surgeries including neurosurgical procedures. In the last 10-15 years there has been an increased use of the endoscope in neurosurgical procedures. If a neurosurgeon wants to use the endoscope, he/she must go through a course and learn a new surgical technique, the endoscopic technique.
Microscopic surgery, on the other side, is a technique generally known by all neurosurgeons and both spinal and intracranial neurosurgery is often performed with the aid of an operating microscope that allows great illumination and 3-D vision in a narrow operating space. Indeed there is virtually no hospital—small or big, community or academic—where neurosurgery is performed that does not have an operating microscope that gets upgraded or even changed every couple of years.
It would be desirable to be able to use the unique advantages of the endoscope and to combine them with established microsurgical techniques. A need exists to combine the beneficial uses of the endoscope to augment many microscopic neurosurgical procedures such as vascular, tumor and spinal procedures, yet no combination exists.